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1. Intracellular monosodium urate crystals = gout. These are yellow & termed negatively birefringent.

2. Evidence of uric acid deposition in the tissues (linear densities overlying cartilage visible on US; uric acid deposits visible on CT; and subcortical bone cysts visible on radiographs/MRI indicative of bony tophi).

3. The uric acid level does not correlate with an attack of acute gout, only confers risk.

4. As serum UA levels increase > 9-10 mg/dL, incidence of gouty attacks increases to 5% per year.

5. Older women may present with polyarticular pseudo-rheumatoid crystalline arthritis (gout or pseudogout that presents similarly to RA) - look for crystals in the joint fluid.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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